Surgical oncology · 2026
A novel delta-shaped esophagojejunostomy after robotic total gastrectomy.
СтатьяНазвание и аннотация: Перевод в очереди
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Suzuki Kazumitsu, Shibasaki Susumu, Watanabe Yusuke, Umeki Yusuke, Serizawa Akiko, Akimoto Shingo, Nakauchi Masaya, Tanaka Tsuyoshi, Inaba Kazuki, Kanaya Seiichiro, Uyama Ichiro, Suda Koichi
Аннотация
BACKGROUND: Esophagojejunostomy following minimally invasive total gastrectomy is technically challenging. We developed a novel intracorporeal delta-shaped esophagojejunostomy using linear staplers following robotic total gastrectomy (RTG). The aim of this study was to verify its safety and feasibility, as compared with established techniques.
METHODS: Of the 85 consecutive RTG cases performed between February 2021 and March 2025, 74 patients were retrospectively analyzed. The cohort consisted of 24 patients who underwent delta-shaped anastomosis, 29 with functional end-to-end anastomosis (FEEA), and 21 with the overlap method. We compared surgical outcomes, including operative variables, anastomotic leakage, and postoperative complications up to 30 days.
RESULTS: No anastomotic leakage occurred in the delta group, whereas one case occurred in the overlap group. The incidence of Clavien-Dindo grade ≥ III complications did not differ significantly among groups. The median anastomotic time with delta-shaped anastomosis was significantly shorter than that with the overlap method (32.0 vs. 45.0 min, p = 0.006) but significantly longer than that with FEEA (23.0 min, p < 0.001). The esophageal resection length was comparable between the delta-shaped anastomosis and FEEA groups; however, the delta-shaped technique required significantly less esophageal mobilization (p < 0.001). No anastomotic strictures were observed within 30 days postoperatively.
CONCLUSIONS: Intracorporeal delta-shaped esophagojejunostomy after RTG is a safe and feasible procedure with favorable short-term outcomes. Achieving anastomosis with less esophageal mobilization under equivalent transection conditions may offer a technical advantage. Further large-scale studies with long-term follow-up are warranted.
METHODS: Of the 85 consecutive RTG cases performed between February 2021 and March 2025, 74 patients were retrospectively analyzed. The cohort consisted of 24 patients who underwent delta-shaped anastomosis, 29 with functional end-to-end anastomosis (FEEA), and 21 with the overlap method. We compared surgical outcomes, including operative variables, anastomotic leakage, and postoperative complications up to 30 days.
RESULTS: No anastomotic leakage occurred in the delta group, whereas one case occurred in the overlap group. The incidence of Clavien-Dindo grade ≥ III complications did not differ significantly among groups. The median anastomotic time with delta-shaped anastomosis was significantly shorter than that with the overlap method (32.0 vs. 45.0 min, p = 0.006) but significantly longer than that with FEEA (23.0 min, p < 0.001). The esophageal resection length was comparable between the delta-shaped anastomosis and FEEA groups; however, the delta-shaped technique required significantly less esophageal mobilization (p < 0.001). No anastomotic strictures were observed within 30 days postoperatively.
CONCLUSIONS: Intracorporeal delta-shaped esophagojejunostomy after RTG is a safe and feasible procedure with favorable short-term outcomes. Achieving anastomosis with less esophageal mobilization under equivalent transection conditions may offer a technical advantage. Further large-scale studies with long-term follow-up are warranted.